Television and on-line media are saturated with advertisements for medications that promise relief from depression, anxiety, and other mood disorders. These messages often offer rapid, near complete recoveries. Understandably, many people are left wondering ‘How accurate are these claims?’ How likely am I to achieve a benefit from my medications? How long do the benefits last? What are the potential risks or trade offs?
This article is intended to provide context, nuance, and compassion while you consider these questions.
Why Listen to Me?
I am a licensed clinical social worker with 25 years of experience practicing psychotherapy, with a specialization in mood and anxiety disorders. Over the course of my career, I have helped thousands of people live happier, stable, more fulfilling lives. In addition to clinical work, I am a published researcher and have spent many years reviewing and engaging with the scientific literature on psychiatric medications, their benefits, limitations, and long-term outcomes.
While I do not prescribed medications, I work closely with clients who take them and with prescribers who manage them. My perspective is grounded in both research and lived clinical experience.
What Does the Research Say About Psychiatric Medications?
In this discussion, I am focusing specifically on medications used to treat mood and anxiety diagnoses which are two of my areas of expertise.
The research on these medications is mixed and, at times, contradictory.. Some studies suggest that approximately 47-50% of individuals experience some symptom improvement on antidepressants. However, remission, as defined by a substantial reduction or disappearance of symptoms, appears to occur in closer to 30%. In my practice, that number appears significantly smaller. Relapse rates are high: approximately 75% of individuals experiencing a first depressive episode relapse, and the rate increases with subsequent episodes. Research shows over 99% of third timers will relapse.
Other research suggests that, for some people, discontinuing antidepressant medications (under appropriate medical supervision) may be associated with better long-term outcomes. These findings underscore that medication responses are highly individualized.
With anxiety disorders, research studies suggests that roughly 36% of individuals achieve some improvement from medication, wile only “a minority” achieve full remission. Remission typically refers to the absence of symptoms for some period of time, though that timeframe is often not clearly defined in the literature. Another consideration is the long term side effects of complete remission from anxiety may include dementia in one’s later years. This is true for any medication that promotes relaxation or sleepiness.
For people diagnosed with bipolar spectrum disorders, remission rates are estimated at approximately 43-44%, though many continue to experience residual symptoms. Some research suggests that as few as 23% achieve full, sustained wellness using medication alone.
Long-Term Considerations
Sadly, the long term results are even worse with medications.
Short-term side effects of psychiatric medications are commonly discussed during prescribing appointments with patients told that these effects will diminish as the body adjusts to the medication. Less frequently discussed, are long-term effects, which may emerge gradually and worsen over time. The longer you use them, often, the worse the side effects will become.
Research suggests that many individuals experience what are referred to as “breakthrough symptomology,” meaning the return of significant symptoms despite continued medication use. Approximately 78% of individuals on a mood-related medication, will experience “break through symptoms” or an episode within five years, often much sooner. In these cases, medication may reduce symptom severity without fully restoring functioning.
At a population level, rates of disability related to brain health conditions have increased substantially since the widespread adoption of psychiatric medications. This trend has also been observed among children as prescribing rates have risen. These patterns raise important questions about how medications are being used, monitored, and integrated with other forms of care. Alarmingly, these figures are sky-rocketing.
Clinical Examples (Names and Identifying Details Changed)
Case Example 1
A few years ago, I worked with a young woman whom I will call Jane, who had complex PTSD related to severe childhood trauma. She had been prescribed benzodiazepines for many years before entering therapy. Part of our work involved helping her develop skills she had never been taught, with the goal of eventually tapering off highly addictive medication.
Unfortunately, several supportive tools that could have eased withdrawal, such as nutritional supplements and assistive devices, were financially out of reach for her. Part of her wanted to reduce while part of her didn’t believe it was possible. These tools included protein isolate, vitamins, and a device that would reduce her withdrawal symptoms. Because of her lack of access, she barely reduced at all.
During the 18-24 months we worked together, it got more difficult to attend sessions in person because she had developed profound hypersomnia, sleeping 21-22 hours per day, along with muscle cramping and significant mobility issues. These symptoms were consistent with other known side effects of long-term benzodiazepine use, though this connection was not acknowledged by her medical providers.
Eventually, she qualified for Social Security Disability and had to discontinue therapy because she could not reliably stay awake for her sessions. At our last contact, she was undergoing extensive medical testing to determine the cause of her symptoms with no conclusive results, testing that may have been avoidable had medication effects been fully considered.
Case Example 2
Another client, whom I worked with for nine years, presented with complex PTSD, Bipolar I disorder, and a Substance Use Disorder in long-term remission. Despite significant challenges, including homelessness, she initially functioned relatively well, working part-time, maintaining a professional appearance, and using coping strategies effectively.
Over time, her stability deteriorated. Her medications became less effective, side effects increased, and she experienced multiple psychiatric hospitalizations. Nutritional deficiencies, including an unacknowledged eating disorder, further compounded her condition. While nutritional support helped somewhat, her overall functioning never fully recovered. The side effects of her medication increasingly interfered with their intended benefits, and it is unlikely she will return to work.
Risks That Are Often Under-Discussed
Many people are aware that antidepressants carry a risk of increased suicidality, particularly in younger populations. Less commonly discussed is the fact that antidepressants can precipitate manic episodes, sometimes leading to a bipolar diagnosis.
Medications used to treat bipolar disorder can themselves cause agitation, irritability, and sleep disruptions, each significant components of mania the those medications are supposed to treat. Long-term use of sedative or sleep-promoting medications has been associated with increased risk of cognitive decline and dementia. Benzodiazepines, in particular, are known to cause memory impairment, sometimes even while the medication is actively working and sometimes when it is wearing off.
Exploring Alternatives and Adjuncts
Medication can be helpful for some people, particularly in the short term or during acute crises. However, it is rarely sufficient on its own and may not be the best long-term solution for everyone. Psychotherapy, nutrition, lifestyle interventions, trauma-informed care, and skills-based approaches are essential components of comprehensive mental health treatment.
If you are interested in learning more about alternative or complementary approaches, you may find the following resources helpful:
- Nutrition and Broad-Spectrum Micronutrients for Mental Health
https://ericalhernandez.com/nutrition-broad-spectrum-micronutrients-for-mental-health/ - Substance Use Prevention Tools to Reduce Reliance on Addictive Medications
https://ericalhernandez.com/substance-use-prevention-tools-to-help-people-avoid-using-addictive-substances/
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